High Turnover in Clinical Dietetics: A Descriptive Analysis

Author(s):  
Sarah J. Hewko ◽  
Samantha Clow ◽  
Amirah Oyesegun ◽  
Charlene Vanleeuwen

Purpose: To identify key attributes of Canadian clinical registered dietitian (RD) jobs associated with high rates of turnover. Methods: Managers of clinical RDs in Canada were eligible to complete a survey on the topic of turnover in clinical RD positions. Specifically, key details were sought regarding positions with the highest and lowest turnover in each manager’s portfolio. Results: High turnover (HT) positions turned over an average of 4.0 times in a 5-year period in contrast to 0.3 times in low turnover (LT) positions. Resignation was the top reason for turnover in both HT and LT positions. HT and LT positions were of analogous full-time equivalent, had comparable caseloads, and served clients/patients with similar diagnoses including diabetes and neurological conditions. Conclusions: There is significant variation in the frequency of turnover across positions in clinical dietetics in Canada. What differentiates HT positions from LT positions remains unclear. More research is required to guide managers seeking to balance turnover and preclude uneven nutrition care quality across units and programs.

2020 ◽  
Author(s):  
Lauren R Sastre ◽  
Leslie T Van Horn

Abstract Background Previous studies have examined barriers (e.g. time) for Family Medicine Providers (FMPs) to provide nutrition and lifestyle counseling, however, to date no studies have examined access or interest to Registered Dietitian Nutritionist (RDN) care for patients. Objective The objective of this study was to explore FMP access, referral practices, barriers and preferences for RDN care. Methods A cross-sectional online survey, with content and face validation was conducted with Family Medicine Departments within large academic health care systems in the Southeastern United States. The main variables of interest included: FMP access, interest, current referrals and referral preferences for RDN care, barriers to referrals and overall perceptions regarding RDN care. Descriptive analysis of close-ended responses was performed with SPSS 26.0. Open-ended responses were analysed using inductive content analysis. Results Over half of the respondents (n = 151) did not have an RDN on-site (64%) yet were highly interested in integrating an RDN (94.9%), with reported preferences for full-time on-site, part-time on-site or off-site RDN care (49.1%, 39.5% and 11.4% respectively). The greatest reported barriers to RDN referrals were perceived cost for the patient (64.47%) and uncertainty how to find a local RDN (48.6%). The most consistent theme reported in the open-ended responses were concerns regarding reimbursement, e.g. ‘Insurance does not cover all of the ways I would like to use an RDN’. Conclusions FMPs report interest and value in RDN services despite multiple perceived barriers accessing RDNs care. Opportunities exist for interprofessional collaboration between dietetic and FMP professional groups to address barriers.


2020 ◽  
Vol 10 (2) ◽  
pp. 55-59
Author(s):  
Irgi Achmad Fahrezy ◽  
ST. Salmia L. A ◽  
Soemanto Soemanto

Pertumbuhanydan permintaan akan sandang yangysemakin meningkat menuntutbperusahan konveksi untuk memiliki tingkat produktifitas yang tinggi, dimana proses ini dapat dilakukan dengan cara meningkatkanbproduktifitas karyawannya. Erlangga Konveksi adalah salah satu perusahaan konveksi yang berdiri tahun 2010. Masalah yang terjadi di Erlangga Konveksi adalah tidak seimbangnya waktu proses produksi pada tiap stasiun kerja yang menyebabkan terjadinya penambahan jumlahpwaktu kerja dan menyebabkan penumpukanfdan banyak kegiatan dari operator yang menghabiskantwaktu dimana operator banyak melakukan kegiatan di luar dari stasiun kerja mereka sendiri untuk membantu operator di stasiun kerja lainya. Untuk itu perlu dilakukan pengukuran beban kerja sebagai dasar perhitungan kebutuhan tenaga kerja yang sesuai pada bagian produksi. Metode yang digunakan dalam penelitian ini adalah metode Full Time Equivalent. Hasil pengukuran menunjukkan beban kerja adalah sebesar 0,33 pada operator gambar pola; 0,29 pada operator  pemotongan 1; 0,31 pada operator pemotongan 2; 0,21 pada operator sablon 1 dan 2; 0,22 pada operator press sablon; 1,24 pada operator jahit obras 1; 1,27 padaooperator jahit obras 2; 0,34 pada operator jahit rantai; 0,25 pada operator cutting sebelumnoverdeck; 0,55 pada operator overdeck 1 dan 2; 0,57 pada operator overdeck 3; 0,18 pada operator quality control 1 dan 2; 0,14 pada operator steam; 0,42 pada operatorpsetrika dan 0,20 pada operator packaging. Berdasarkan beban kerja yang telah dihitung pada masing-masing operatorybagian produksi Erlangga Konveksi, Malang, jumlah tenaga optimal pada bagian produksi adalah sebanyak 7 orang yang terbagi ke dalam 7 stasiun kerja.


Author(s):  
Tat Ming Ng ◽  
Sock Hoon Tan ◽  
Shi Thong Heng ◽  
Hui Lin Tay ◽  
Min Yi Yap ◽  
...  

Abstract Background The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. We aim to investigate effects of reduction in AMS resources during the COVID-19 pandemic on antimicrobial prescribing. Methods One of 5 full-time equivalent AMS pharmacists was deployed to support pandemic work and AMS rounds with infectious disease physicians were reduced from 5 to 2 times a week. A survey in acute inpatients was conducted using the Global Point Prevalence Survey methodology in July 2020 and compared with those in 2015 and 2017–2019. Results The prevalence of antimicrobial prescribing (55% in 2015 to 49% in 2019 and 47% in 2020, p = 0.02) and antibacterials (54% in 2015 to 45% in 2019 and 42% in 2020, p < 0.01) have been reducing despite the pandemic. Antimicrobial prescribing in infectious disease wards with suspected or confirmed COVID-19 cases was 29% in 2020. Overall, antimicrobial prescribing quality indicators continued to improve (e.g. reasons in notes, 91% in 2015 to 94% in 2019 and 97% in 2020, p < 0.01) or remained stable (compliance to guideline, 71% in 2015 to 62% in 2019 and 73% in 2020, p = 0.08). Conclusion During the COVID-19 pandemic, there was no increase in antimicrobial prescribing and no significant differences in antimicrobial prescribing quality indicators.


Author(s):  
Belinda Jessup ◽  
Tony Barnett ◽  
Kehinde Obamiro ◽  
Merylin Cross ◽  
Edwin Mseke

Background: On a per capita basis, rural communities are underserviced by health professionals when compared to metropolitan areas of Australia. However, most studies evaluating health workforce focus on discrete professional groups rather than the collective contribution of the range of health, care and welfare workers within communities. The objective of this study was therefore to illustrate a novel approach for evaluating the broader composition of the health, welfare and care (HWC) workforce in Tasmania, Australia, and its potential to inform the delivery of healthcare services within rural communities. Methods: Census data (2011 and 2016) were obtained for all workers involved in health, welfare and care service provision in Tasmania and in each statistical level 4 area (SA4) of the state. Workers were grouped into seven categories: medicine, nursing, allied health, dentistry and oral health, health-other, welfare and carers. Data were aggregated for each category to obtain total headcount, total full time equivalent (FTE) positions and total annual hours of service per capita, with changes observed over the five-year period. Results: All categories of the Tasmanian HWC workforce except welfare grew between 2011 and 2016. While this growth occurred in all SA4 regions across the state, the HWC workforce remained maldistributed, with more annual hours of service per capita provided in the Hobart area. Although the HWC workforce remained highly feminised, a move toward gender balance was observed in some categories, including medicine, dentistry and oral health, and carers. The HWC workforce also saw an increase in part-time workers across all categories. Conclusions: Adopting a broad approach to health workforce planning can better reflect the reality of healthcare service delivery. For underserviced rural communities, recognising the diverse range of workers who can contribute to the provision of health, welfare and care services offers the opportunity to realise existing workforce capacity and explore how ‘total care’ may be delivered by different combinations of health, welfare and care workers.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 638-639
Author(s):  
Karen Roberto ◽  
Jyoti Savla ◽  
Steven Zarit

Abstract The daily lives of family caregivers of persons with dementia (PwD) often require that they manage multiple competing demands in a context of unpredictability. Memory and behavior changes associated with dementia can cause PwD to act in random and irrational ways that create stress and influence all aspects of caregivers’ everyday life. Supportive others, including informal helpers and formal service professionals, should provide relief to primary caregivers; however, help may not alleviate caregiver stress and can sometimes compound the burden of care. This symposium draws on daily diary surveys and face-to-face interviews to focus on four aspects of managing everyday care of PwD among family caregivers in rural areas. Brandy Renee McCann explores how caregivers’ vigilance on behalf of PwD care quality interacts with service use. Karen Roberto examines the ways in which caregivers manage PwD resistance to help, including their use of forceful care strategies. Rosemary Blieszner focuses on competing caregiver roles and demands that may contribute to or alleviate caregiver stress. Tina Savla addresses the unexpected, and often hidden, challenges involved in using formal services. Collectively, the four presentations provide in-depth insight into the complicated daily lives of families coping with dementia and the ways in which they meet the demands of full-time caregiving under often difficult and challenging circumstances. Discussant Steve Zarit considers the efficacy of these management strategies for various aspects of everyday care and offers suggestions for future research and person-centered programs and interventions to reduce health disparities among caregivers in rural areas.


Author(s):  
Jonathon Oden

Abstract The purpose of this study was to descriptively analyze music therapy employment data from 2013 to 2019, including years in the field, gender, age, ethnicity, hours worked, jobs created, number of new board-certified music therapists (MT-BCs), funding sources, and wages. A database was created to analyze descriptive data from the 2013–2019 American Music Therapy Association Workforce Analysis Surveys as well as data from the Certification Board for Music Therapists. Results indicate a large portion of music therapists (MTs) have been in the field for five years or less. Though the majority of MTs work full time, there is a high rate of part-time employment. An estimate of the total number of new full-time jobs represented a ratio of 57% of new MT-BCs during the period. Private pay was the most reported funding source for music therapy services. Music therapy wages tended to be higher for those with higher levels of education. Limitations of the study and suggestions for future research are provided.


Author(s):  
Ishaan Gupta ◽  
Zishan K. Siddiqui ◽  
Mark D. Phillips ◽  
Amteshwar Singh ◽  
Shaker M. Eid ◽  
...  

Abstract In response to the coronavirus disease 2019 (COVID-19) pandemic, the State of Maryland established a 250-bed emergency response field hospital at the Baltimore Convention Center to support the existing healthcare infrastructure. To operationalize this hospital with 65 full-time equivalent (FTE) clinicians in less than four weeks, more than 300 applications were reviewed, 186 candidates were interviewed, and 159 clinicians were credentialed and onboarded. The key steps to achieve this undertaking involved employing multidisciplinary teams with experienced personnel, mass outreach, streamlined candidate tracking, pre-interview screening, utilizing all available expertise, expedited credentialing, and focused onboarding. To ensure staff preparedness, the leadership developed innovative team models, applied principles of effective team building, and provided ‘just in time’ training on COVID-19 and non-COVID-19 related topics to the staff. The leadership focused on staff safety and well-being, offered appropriate financial remuneration and provided leadership opportunities that allowed retention of staff.


2016 ◽  
Vol 42 (2) ◽  
pp. 85-98
Author(s):  
Roland Zullo

I investigate the feasibility of completely privatizing prison physical and mental health service. The study is based on bid documents from Michigan’s 2012 exploration of privatized health care, along with historical documents. Five lessons are reported: (1) Price differences are largely attributable to staffing strategies, with private agents using fewer full-time equivalent (FTE) and less-qualified staff; (2) privatization ushers in personnel practice that is less structured for long-term employee retention; (3) managed competition is impractical due to qualified provider scarcity and desirability of client-patient continuity; (4) tension between best practice medicine and the profit motive is unresolvable, which necessitates diligent monitoring; and (5) privatization ideology is a powerful force that is external to the public interest but one that can be challenged by “good government” coalitions.


JAMIA Open ◽  
2018 ◽  
Vol 1 (2) ◽  
pp. 188-194 ◽  
Author(s):  
William R Hersh ◽  
Keith W Boone ◽  
Annette M Totten

Abstract Objective There is little readily available data about the size and characteristics of the healthcare information technology workforce. We sought to update a previous description of the size, growth, and characteristics of this workforce based on the Healthcare Information Management Systems Society (HIMSS) Analytics® Database, a resource that includes hospital size, number of beds, amount of staffing, and an eight-stage model of electronic health record adoption (Electronic Medical Record Adoption Model, EMRAM℠). Materials and Methods We updated an analysis done using a 2007 snapshot of the HIMSS Analytics Database with a comparable snapshot from 2014 in order to estimate the size of the current workforce and project future needs. For the 2014 data, we applied the same weighted average analysis used in 2007 to obtain a ratio of information technology (IT) hospital full-time equivalent (FTE) to staffed beds, extrapolate the results to all US hospitals, and project the workforce needs as hospitals achieve higher EMRAM stages. Results Our estimated size of the healthcare information technology workforce in the US in 2014 was 161 160, which was 8.0% larger than the estimate based on the 2007 data. Based on the new data, we project a potential need for an additional 19 852 and 153 114 FTE, if all hospitals were to achieve EMRAM Stages 6 and 7, respectively. The distribution of FTE across job function category varies by EMRAM stage. Discussion and Conclusions Although these data are limited, especially for EMRAM Stage 7, there is likely need for substantial workforce growth as hospitals increase their adoption of advanced healthcare information technology. Further research with data better focused on workforce characteristics will provide a better picture of staffing requirements.


2018 ◽  
Vol 34 (4) ◽  
pp. 389-397
Author(s):  
Joseph Featherall ◽  
Alexander Chaitoff ◽  
Anthony Simonetti ◽  
James Bena ◽  
Daniel Kubiak ◽  
...  

Transforming health care remains a challenge as many continuous improvement (CI) initiatives fail or are not sustained. Although the literature suggests the importance of culture, few studies provide evidence of cultural change creating sustained CI. This improvement initiative focused on creating cultural change through goal alignment, visual management, and empowering frontline employees. Data included 113 133 encounters. Cochran-Armitage tests and X-bar charting compared wait times during the CI initiative. Odds of waiting <15 minutes increased in both phase 2 (odds ratio = 3.57, 95% confidence interval = [3.43-3.71]) and phase 3 (odds ratio = 5.39, 95% confidence interval = [5.07, 5.74]). At 3 years follow-up, 95% of wait times were <15 minutes. Productivity increased from 519 to 644 patients/full-time equivalent/month; 33/42 Press Ganey employee engagement components significantly improved. This study demonstrates the efficacy of a culture of CI approach to sustain wait time improvement in outpatient laboratory services, and should be considered for application in other areas of health care quality.


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